PCSK9抑制剂在不同危险分层动脉粥样硬化性心血管疾病PCI术后的应用价值

Application Value of PCSK9 Inhibitor after PCI in Atherosclerotic Cardiovascular Disease with Different Risk Stratification

目的探讨前蛋白转化酶枯草溶菌素9(PCSK9)抑制剂联合中等强度他汀类药物在不同危险分层动脉粥样硬化性心血管疾病(ASCVD)经皮冠状动脉介入(PCI)术后的应用效果及安全性。方法回顾性分析2020年1—6月收治的ASCVD经PCI术后应用PCSK9抑制剂联合中等强度他汀类药物治疗的200例的临床资料,依据危险分层分为超高危组和非超高危组,每组100例。所有患者在中等强度他汀类药物治疗的基础上加用PCSK9抑制剂,比较治疗前后血脂及超敏C反应蛋白(hs-CRP)水平变化情况、不良事件发生率。结果超高危组治疗前hs-CRP高于非超高危组(P<0.05)。2组治疗后总胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、hs-CRP及脂蛋白-α(Lp-α)均低于治疗前,高密度脂蛋白胆固醇高于治疗前,超高危组Lp-α水平低于非超高危组(P<0.05)。2组LDL-C下降幅度比较差异无统计学意义(P>0.05)。超高危组LDL-C达标率为70.0%,非超高危组LDL-C达标率为82.5%。2组治疗后心血管不良事件发生率比较差异无统计学意义(P>0.05)。2组均未发生严重不良反应。结论PCSK9抑制剂可明显降低不同危险分层ASCVD患者PCI术后LDL-C、Lp-α水平,且安全性良好。

Objective To investigate the efficacy and safety of the combination of proprotein convertase subtilisin/Kexin type 9(PCSK9)inhibitor and medium intensity statins in patients with atherosclerotic cardiovascular disease(ASCVD)in different risk stratification after percutaneous coronary intervention(PCI).Methods A retrospective analysis was conducted on the clinical data of 200 patients with ASCVD treated with PCSK9 inhibitors combined with moderate intensity statins after PCI from January to June 2020.They were divided into ultra-high risk group and non-ultra-high risk group based on risk stratification,with 100 patients in each group.All patients were treated with moderate intensity statins supplemented with PCSK9 inhibitors.The changes in blood lipid levels and hypersensitive C reactive protein(hs-CRP)and the incidence of adverse events were compared before and after treatment.Results Before treatment,hs-CRP in the ultra-high risk group was higher than that in the non-ultra-high risk group(P<0.05).Total cholesterol,triacylglycerol,low-density lipoprotein cholesterol(LDL-C),hs-CRP and lipoprotein-α(Lp-α)in both groups were lower after treatment than those before treatment,while high-density lipoprotein cholesterol(HDL-C)was higher than that before treatment,and the level of Lp-αin the ultra-high risk group was lower than that of the non-ultra-high risk group(P<0.05).There was no statistically significant difference in the decrease in LDL-C between the two groups(P>0.05).The LDL-C compliance rate was 70.0%in the ultra-high risk group and 82.5%in non-ultra-high risk group.There was no statistically significant difference in the incidence of cardiovascular adverse events between the two groups after treatment(P>0.05).No serious adverse reactions occurred in both groups.Conclusion PCSK9 inhibitors can significantly reduce postoperative LDL-C and Lp-αlevels in ASCVD patients with different risk stratification after PCI,showing good safety.